【作者】 张代民；

【导师】 郭涛； 赵淮；

【作者基本信息】 昆明医学院 ， 内科学， 2003， 硕士

【摘要】 目的 在连续随访起搏患者的过程中，动态调整起搏参数和／或起搏系统硬件，探讨动态优化起搏系统改善患者生活质量的效果及其方法学。方法120例接受永久起搏治疗的患者，男79例，女41例，年龄63.7±12.5(16～83)岁。其中右房双室三腔起搏16例，双房右室三腔起搏11例，普通DDD起搏57例，抗房颤起搏18例，VVI起搏18例。随访最短3月、最长30月、平均21±5.9月。随访期间采用常规心电图、动态心电图、超声心动图、6分钟步行测距、生活质量评分等指标，观察起搏系统干预前后的疗效、心功能分级和生活质量变化。结果随访期内实施起搏系统干预共387例次，其中调整AVD61例(含双室起搏16例)，调整起搏频率42例；调整感知性能20例；改变起搏模式6例；起搏故障探查术5例；VVI改DDD6例，患者左室射血分数、6分钟步行距离和生活质量评分均分别提高9.83％、82.67米和13.66分(均P＜0.05)，心功能分级和住院频率分别下降1.5级和0.75次(P＜0.05)；3例起搏器介导性心动过速被纠治；6例持续性房颤患者加行房室结阻断术后有效控制了心室率。优化起搏系统前后，“起搏患者生活质量测评”和SF-36问卷的分值均有提高(P＜0.05)、提高程度的差异有显著性(P＜0.05)且2种量表的相关性良好(r=0.62，p＜0.05)。结论优化起搏系统可确保起搏治疗高效、安全、节能，显著提高患者生活质量；起搏系统优化应坚持提高随访效率、因人而异、因时而异、兼顾节能的原则；“起搏患者生活质量测评表”可用于起搏患者的生活质量评价。更多还原

【Abstract】 Objective To observe the effects and explore methodology of pacing system modified on quality of life of patients by dynamical adjusting pacemaker parameters and/or pacing hardware during continuous follow-up. Methods 120 patients who were implantated pacemakers were selected, including biventricular pacing 16, biatrial pacing 11, double chamber pacemakers 57, antiatrifibrillation pacemakers 18, single chamber pacemakers 18. Follow-up time was from 3 months to 30 months, mean 21±5.9 months. Many markers, such as ECG, Holier- monitoring electrocardigram, ultrasonic cardiogram, cardiac function, 6 minutes walk, sores of questionnaires of quality of life, were performed for evaluating the effect of treatments, change of quality of life and class of cardiac function pro- and post- modified pacing system during follow-up. It was important for different patients and varied time, to select different markers. Results adjust AVD 61 cases (including biventricular pacing 16 cases); adjust pacing frequency 42 cases; adjust pacing sensation 20 cases (including PMT 2 cases); adjust pacing pattern 6 cases (including PMT 3 cases); check pacing malfunction 5 cases. Left ventricular ejection fraction, 6 minutes walk and questionnaires of quality of life were remarkably improved after modified pacing system both 6 patients by changing single chamber pacemaker into double chamber pacemaker and 16 bioventricular pacing by choosing the best AV Delay, meanwhile, the NYHA class of heart failure and frequency of hospitalization were better than that of pre-modified pacing system. Tachycardia, induced by pacemaker in 3 patients including 2 patients with biatrial pacemaker and 1 patient with double chamber pacemaker, was stopped by modified pacing system. Single chamber pacemakers were implanted in 6 patients with permanency atrial fibrillation after atrial ventricular node of the six patients were blocked. The scores of SF-36 and QLIPP (quality of life instrument for patients with pacemaker) were higher than before modified pacing system. Conclusion To ensure pacing therapeutic efficacy and improve significantly quality of life for patients with pacemakers by modified pacing system; To improve efficiency of follow-up according to different patients and varied time; To give consideration to principle of saving energy should be persisted; Questionnaires of quality of life for patients with pacemaker could evaluated quality of life for patients with pacemaker.更多还原